Vanguard Neurologist

From ScienceDaily.com:

Staying in a multi-bed hospital room dramatically increases the risk of acquiring a serious infectious disease, Queen’s University researchers have discovered.

A new study led by infectious diseases expert Dr. Dick Zoutman says the chance of acquiring serious infections like C. difficile (Clostridium difficile) rises with the addition of every hospital roommate.

“If you’re in a two, three or four-bedded room, each time you get a new roommate your risk of acquiring these serious infections increases by 10 per cent,” says Dr. Zoutman, professor of Community Health and Epidemiology at Queen’s. “That’s a substantial risk, particularly for longer hospital stays when you can expect to have many different roommates.”

Dr. Zoutman suggests hospitals need to consider more private rooms in their planning. “Despite other advances, multi-bedded rooms are still part of hospital design in the 21st century. Building hospitals with all private rooms is not yet the standard in Ontario or Canada — but it should be.”

Also on the Queen’s team are master’s student Meghan Hamel and Associate Professor Christopher O’Callaghan. The findings are published on-line in the American Journal of Infection Control.

The researchers argue that it’s cheaper in the long run to build more private rooms because of the high costs of treating people with superbugs. For facilities with multi-bed rooms that are unable to take on major redesign, Dr. Zoutman suggests converting four-bed rooms to two-bed semi-privates, and changing semi-private rooms in high-risk areas to private rooms, as much as possible.

“One important way to improve patient safety in our hospitals is to reduce the number of roommates that patients are exposed to during their hospital stay,” he stresses. “Especially in acute care hospitals, where the risks are highest, we need to change our room configurations as much as current resources will allow, and strive to design and build new hospital facilities with entirely private rooms.”

From ScienceDaily.com:

Believing in God can help block anxiety and minimize stress, according to new University of Toronto research that shows distinct brain differences between believers and non-believers.

In two studies led by Assistant Psychology Professor Michael Inzlicht, participants performed a Stroop task – a well-known test of cognitive control – while hooked up to electrodes that measured their brain activity.

Compared to non-believers, the religious participants showed significantly less activity in the anterior cingulate cortex (ACC), a portion of the brain that helps modify behavior by signaling when attention and control are needed, usually as a result of some anxiety-producing event like making a mistake. The stronger their religious zeal and the more they believed in God, the less their ACC fired in response to their own errors, and the fewer errors they made.

“You could think of this part of the brain like a cortical alarm bell that rings when an individual has just made a mistake or experiences uncertainty,” says lead author Inzlicht, who teaches and conducts research at the University of Toronto Scarborough. “We found that religious people or even people who simply believe in the existence of God show significantly less brain activity in relation to their own errors. They’re much less anxious and feel less stressed when they have made an error.”

These correlations remained strong even after controlling for personality and cognitive ability, says Inzlicht, who also found that religious participants made fewer errors on the Stroop task than their non-believing counterparts.

Their findings show religious belief has a calming effect on its devotees, which makes them less likely to feel anxious about making errors or facing the unknown. But Inzlicht cautions that anxiety is a “double-edged sword” which is at times necessary and helpful.

“Obviously, anxiety can be negative because if you have too much, you’re paralyzed with fear,” he says. “However, it also serves a very useful function in that it alerts us when we’re making mistakes. If you don’t experience anxiety when you make an error, what impetus do you have to change or improve your behaviour so you don’t make the same mistakes again and again?”

The paper, appearing online in Psychological Science, was co-authored by Dr. Ian McGregor at York University, and by Jacob Hirsh and Kyle Nash, doctoral candidates at the University of Toronto and York University, respectively.

1. “Rheumatoid arthritis (RA) is associated with increased risk for cardiovascular (CV) events through multiple factors. Fish oil has been shown to reduce symptoms in RA and to reduce CV risk. Researchers assessed the effect of an anti-inflammatory dose of fish oil on CV risk factors within a program of combination chemotherapy for patients with early RA. Thirteen patients who chose not to take fish oil were compared with 18 patients who consumed 4 grams of EPA and 10 grams of DHA from fish oil.
“After 3 years researchers examined the content of arachidonic acid (AA) in cells, synthesis of thromboxane A2 and prostaglandin E2, use of nonsteroidal antiinflammatory drugs (NSAIDs), traditional CV lipid risk factors, and disease activity. AA was 30% lower in platelets and 40% lower in peripheral blood mononuclear cells in subjects taking fish oil. Serum thromboxane B2 was 35% lower and lipopolysaccharide-stimulated whole-blood prostaglandin E2 was 41% lower with fish oil ingestion compared to no fish oil. NSAID use was reduced by 75% from baseline with fish oil and by 37% without fish oil. Favorable changes in fasting blood lipids were seen with, but not without fish oil. Remission at 3 years was more frequent with fish oil use (72%) compared to no fish oil (31%). Researchers concluded that fish oil reduces cardiovascular risk in patients with RA through multiple mechanisms.”
Cleland, LG et.al. “Reductions of cardiovascular risk factors with long term fish oil treatment in early rheumatoid arthritis” 2006; Journal of Rheumatology: 33(10): 1973-1979
2. Edible Schoolyard: A Universal Idea by Alice Waters; photographs by David Liittschwager; 80 color photographs; December, 2008
“One of America’s most influential chefs, Alice Waters created a revolution in 1971 when she introduced local, organic fare at her Berkeley, California, restaurant, Chez Panisse. Twenty-five years later, she and a small group of teachers and volunteers turned over long-abandoned soil at an urban middle school in Berkeley and planted the Edible Schoolyard.
The schoolyard has since grown into a universal idea of Edible Education that integrates academics with growing, cooking, and sharing wholesome, delicious food. With inspiring images of the garden and kitchen—and their young caretakers—Edible Schoolyard is at once a visionary model for sustainable farming and childhood nutrition, and a call to action for schools across the country.”

3. Dutch researchers prospectively investigated whether organic food consumption by infants was associated with developing atopic manifestations in the first 2 years of life. The KOALA Birth Cohort Study in the Netherlands (n=2764) measured organic food consumption, eczema, and wheeze in infants until age 2 years using repeated questionnaires. Diet was defined as conventional when less than 50 % of food consumed was organic, moderately organic when 50–90 % of food consumed was organic, and strictly organic when more than 90 % of food consumed was organic. Of all the children, 10 % had consumed a moderately organic diet and 6 % a strictly organic diet. Eczema was present in 32 % of infants, recurrent wheeze in 11 % and prolonged wheezing in 5 %.

Venous blood samples taken from 815 infants at 2 years of age were analyzed for total and specific IgE. At 2 years of age, 27 % of children were sensitized against at least one allergen. Consumption of organic dairy products was associated with lower eczema risk, but there was no association with organic meat, fruit, vegetables or eggs, or the proportion of organic products within the total diet with the development of eczema, wheeze or atopic sensitisation. Further studies to substantiate these results are warranted.
Kummeling, I. et.al., “Consumption of organic foods and risk of atopic disease during the first 2 years of life in the Netherlands”, 2008; British Journal of Nutrition; 99:598-605

Brain Cells Are Discovered That Only Respond to Certain Celebrities; One May Worship Homer Simpson but Ignore Madonna

From WSJ.com:

Researchers have discovered that in the vast neural network of the brain, some cells are, to use a technical term, celebrity groupies.
Probing deep into human brains, a team of scientists discovered a neuron roused only by Ronald Reagan, another cell smitten by the actress Halle Berry and a third devoted solely to Mother Teresa. Testing other single human neurons, they located a brain cell that would rather watch an episode of “The Simpsons” than Madonna.
In one sense, these findings are merely noise. They arise from rare recordings of electrical activity in brain cells, collected by neuroscientists at the University of California, Los Angeles, during a decade of experiments with patients awaiting brain surgery for severe epilepsy. These tingles of electricity, however, gave the researchers the opportunity to locate neurons that help link our perceptions, memories and self-awareness.
In their most recent work this year, the research team reported that a single human neuron could recognize a personality through pictures, text or the sound of a name — no matter how that person was presented. In tests, one brain cell reacted only to Oprah Winfrey; another just to Luke Skywalker; a third singled out Argentine soccer star Diego Maradona.
Each neuron appeared to join together pieces of sensory information into a single mental impression. The researchers believe these cells are evidence that it only takes a simple circuit of neurons to encode an idea, perception or memory.
“These neurons will fire to the person no matter how you present them,” says bioengineer Rodrigo Quian Quiroga at the U.K.’s University of Leicester who studied the neurons with colleagues at UCLA and the California Institute of Technology. “All that we do, all that we think, all that we see is encoded by neurons. How do the neurons in our brain create all our perceptions of the world, all our emotions, all our thinking?”
At its simplest, a neuron is a nerve cell, one of the myriads that make up our central nervous system. Each cell can send and receive the electro-chemical signals that charge our thoughts and emotions.
On average, there are more neurons in the human brain than there are galaxies in the known universe — about 100 billion in all, arranged on a scaffold of one trillion or so supporting, thread-like glial cells. Our inspirations race through thousands of miles of nerve fibers and axons so compacted that our entire neural network is no larger than a coconut. No two brains are alike, not even those of identical twins.
To these researchers, neurons are the Lego bricks of the brain — a construction kit that can self-assemble into a cathedral of thought. “The idea of justice is probably generated by a small set of neurons firing,” says Caltech biophysicist Christof Koch, who studies the biological basis of consciousness. “It must be true of all the things that we think about … the number pi …God.”
In some ways, each neuron does act as if it has a mind of its own. Some fire only when they perceive a straight line; others just when they detect a right angle. New neurons form every day. No one knows how the cells can encode a complex thought or how so many neurons can make a mind.
Most of what we have learned about their neurobiology comes through imaging studies, post-mortem analysis or animal experiments. Under normal circumstances, researchers can’t directly probe the cells of an awake, living human brain for ethical reasons.
In 1997, though, UCLA neurosurgeon Itzhak Fried and his colleagues started studying epilepsy patients who, as part of normal preparation for surgery, have electrodes implanted deep in their brain tissue. These electrodes are used to record neural activity that could identify the source of the patients’ intractable seizures. They also detect the activity of healthy cells around the electrodes, which gives the scientists an opportunity to study the biology of perception and memory. “This really offers us a glimpse into the human mind,” says Dr. Fried.
In five provocative experiments since 2005, the researchers used pictures of famous faces and places to screen neurons in brain areas that gather information from all our senses about a person or place we know and blend them into a long-term memory.
To start, Dr. Fried and his colleagues showed eight epilepsy patients 80 images of celebrities, animals, common objects and landmarks while recording the electrical activity of neurons wired to electrodes. They flashed each image for a second, shuffled the sequence into random order and then repeated it. They did that six times.
“You would present hundreds of stimuli — faces or celebrities or famous landmarks — and the neuron would respond to only one or two,” Dr. Fried says. “The incredible specificity was striking.”
In the magazine rack of the mind, some cover girls have a neuron all their own. Testing one patient, the researchers found a neuron that reacted instantly when shown almost any picture of Jennifer Aniston. This cell ignored other celebrities. It gave the cold shoulder to pictures of the actress with her former husband Brad Pitt. “The cells seemed to respond to the idea of Jennifer Aniston,” says Dr. Koch.
Testing a second patient, the researchers found a neuron that responded only to Halle Berry. The cell’s electrical activity jumped no matter how the actress was posed or how she was dressed. Again, this neuron showed no interest in other celebrities or to any other images of common objects or places.
Subsequent tests turned up single neurons in patients that fired selectively to pictures of former President Bill Clinton, The Beatles, or basketball player Michael Jordan. Each of these individual neurons behaved in a way that made the researchers believe that the cell was responding to a distillation of experience. “The neuron is responding to a concept, not a picture,” says Dr. Quian Quiroga. Moreover, each neuron acted as a trigger for recalling the concept they helped encode.
During a follow-up study at UCLA last year, the researchers showed 13 new volunteers wired to neural electrodes a set of 48 short video segments. In part, they wanted to see if neurons attuned any differently to moving pictures and changing scenery.
In fact, some cells did respond strongly to one video clip but not to others. In one patient, the researchers found a neuron that acted up only to The Simpsons cartoon series. “The neuron would spring to life when you showed the video of The Simpsons,” says Dr. Fried.
To be sure, few of us likely have a special brain cell devoted to Jennifer Aniston or Homer Simpson. Our cells are sensitive to more than brand names. They can attune themselves quickly to new people or places, often within a day. While monitoring one new patient’s brain, Dr. Quian Quiroga was surprised to encounter a neuron that already had him in mind.
“Suddenly,” he says, “I find a neuron firing in response to me.”

From USAToday.com:

Elizabeth Kunz left her dentist’s office this spring with a mouth full of problems and no way to pay for them.
The South Carolina resident went out of her way, literally, to find a solution, which turned out to be in Central America. Her trip to the tropics is part of a health insurance experiment for trimming medical costs: overseas care.

As Washington searches for ways to tame the country’s escalating health care costs, more insurers are offering networks of surgeons and dentists in places like India and Costa Rica, where costs can be as much as 80% less than in America.

Until recently, most Americans traveling abroad for cheaper non-emergency medical care were either uninsured or wealthy. But the profile of medical tourists is changing. Now, they are more likely to be people covered by private insurers, which are looking to keep costs from spiraling out of control.

The four largest commercial U.S. health insurers — with enrollments totaling nearly 100 million people — have either launched pilot programs offering overseas travel or explored it. Several smaller insurers and brokers also have introduced travel options for hundreds of employers around the country.

Growth has been slow in part because some patients and employers have concerns about care quality and legal responsibility if something goes wrong. Plus, patients who have traditional plans with low deductibles may have little incentive to take a trip.

But a growing number of consumers with high-deductible plans, which make patients pay more out of pocket, could make these trips more inviting.

In the meantime, the insurance industry’s embrace of overseas care has had a pleasant side effect at home: some U.S. care providers are offering price breaks to counter the foreign competition.

This domestic competition and the slumping economy have led to slower growth for medical tourism over the past year, as patients put off elective procedures that involve big out of pocket costs, said Paul Keckley, executive director of the Deloitte Center for Health Solutions.

Last year, the center estimated that 6 million Americans would make medical tourism trips in 2010. But Keckley has since shaved that projection to about 1.6 million people. Still, that more than doubles the roughly 750,000 Americans who traveled abroad in 2007, the last year for which Deloitte had actual numbers.

Keckley expects the medical tourism industry to recover, as more health insurers offer the option and as more people wind up with high-deductible plans.

Health care costs for employers who offer insurance to their workers were projected to rise 9.2% this year and another 9% in 2010, according to the consulting firm PricewaterhouseCoopers. That could mean double-digit percentage increases for employees through higher premiums, deductibles or copays.

Overseas care can lead to price breaks of more than $40,000, not counting travel costs, for procedures like knee replacement surgery or heart bypasses. Insurers, or employers who provide their own insurance, can save between 50% and 90% on major medical claims, said Jonathan Edelheit, president of the Florida-based Medical Tourism Association. A lower cost of living and lower prices for medical supplies and drugs help drive down care costs overseas compared to American providers.

While employers or insurers reap much of the savings, these lower costs can be the difference between a manageable expense and a bank-breaker for patients with high-deductible plans. These increasingly popular plans can lead to out-of-pocket expenses surpassing $5,000 for individual coverage and $10,000 for family plans.

High out of pocket costs also are common with dental coverage, which is one reason dental care trips have proven popular.

Kunz, 47, initially doubted the potential savings she might see from visiting a Costa Rican dentist though a program offered by her insurer, BlueCross BlueShield of South Carolina. But a little comparison shopping — with help from the insurer — persuaded her to get on a plane.

She had eight crowns replaced, a tooth filled and root canal. The work would have cost her $10,000 out of pocket back home, but she paid just $2,800 after insurance.

Ben Schreiner of Camden, S.C., would have paid the entire $10,000 deductible on his insurance policy if he had his hernia surgery done last year near home. For that reason, Schreiner, 63, had planned to wait until he turned 65 and qualified for Medicare before fixing it.

After reading about medical tourism in his insurer’s annual report, the retired bank executive flew to Costa Rica and paid about $4,400, including travel expenses. Frequent flier miles covered his flight.

Schreiner said he was initially skeptical about the quality of care he might receive but reading about the doctors who could perform the surgery put him at ease.

“When you read the bios and the backgrounds of the doctors, you kind of lose your skepticism,” he said.

However, apprehension about medical travel remains a high hurdle.

“People still do not understand that there could be a hospital in Thailand that can be as good as any hospital anywhere in the world or in the United States,” said John Ferguson, chief marketing officer for Georgia-based BasicPlus Insurance Services.

BasicPlus, which underwrites and provides group health insurance plans to employers, started offering medical tourism as part of a benefits package last year. About 200 employers it contracts with around the country now offer that option, but no patients have used it.

Quality can be a legitimate worry, said Harvard Medical School professor Sharon Kleefield, who has worked overseas with several health care systems to establish quality measurements.

The average patient has no way of comparing hospitals worldwide on quality, which can vary widely. But, Kleefield said, insurers are helping to raise standards through careful inspections of hospitals before including them in an overseas network.

Concerns about liability also may be keeping some employers from adding overseas care options to their plans.

U.S. employers who encourage an overseas medical trip could become litigation targets. It can be difficult to sue an overseas provider in U.S. courts, said Nathan Cortez, a Southern Methodist University law school professor who studies medical tourism. And the average malpractice recovery in Thailand is about $3,000, roughly 1% of the U.S. average.

To ease this fear, medical tourism companies have started offering insurance that protects employers who send employees overseas from liability.

Some employers also have learned they don’t have to send people overseas to save money.

Shortly after Hartford, Conn.-based Aetna Inc. and the Maine-based grocery chain Hannaford Bros. Co. launched a program to send patients to Singapore for hip and knee replacements, some New England hospitals countered with their own deals.

So far, three patients have benefited from the competitive pricing; Hannaford has sent no one overseas, even though the program pays travel and lodging costs.

“People travel all the time a couple hours on the interstate,” said Dr. Brian Kelly, Aetna’s national medical director. “That’s no big deal.”